PAN Calendar

Joint Convention of the Philippine Association of Nutrition (PAN), Inc.

and Philippine Society of Nutritionist-Dietitians (PSND), Inc.

Century Park Hotel Manila, 6-7 July 2016

Background

The Philippine Association of Nutrition (PAN), Inc. and the Philippine Society of Nutritionists-Dietitians (PSND), Inc. conducted a joint convention last 6-7 July 2016 at the Century Park Hotel in Malate, Manila. In line with this celebration, this year’s joint convention theme focused on “Empowering and Strengthening Partnerships for the First 1000 Days” in connection with this year’s Nutrition Month theme “First 1000 Days ni baby pahalagahan para sa malusog na kinabukasan.”

The first 1000 days of a child’s life, from prenatal to his second birthday, is critical because it sets the foundation for a healthy growth and development. Good nutrition during this period reduces the risks of stunting, which may limit one’s ability to grow, learn, socialize and productively work later in life. To help strengthen the capacities of national and local partners to promote, support and execute the First 1000 Days initiative, the PAN and PSND staged this convention to engage relevant stakeholders in discussions on maternal nutrition, birth outcomes and lifelong health; challenges of and strategies towards the reduction of adolescent pregnancies; and newborn care and addressing barriers to immediate, exclusive and continued breastfeeding.

The increasing number of Filipinos suffering from chronic malnutrition manifested in terms of linear growth retardation or stunting is very alarming. Currently, the Philippines is among the top countries in the world which has high prevalence of stunting among its population. However, chronic malnutrition is a preventable condition. Similar to other non-communicable lifestyle-related diseases, nutrition plays a key role in addressing chronic malnutrition.

Through this convention, experts both from local and international agencies and organizations were able to impart knowledge and share relevant experiences on the key concepts, principles and best practices in the first 1000 days of life.

Preliminaries

Dr. Leonora N. Panlasigui, President of PAN, Inc. welcomed about 800 guests and participants from different nutrition and allied health professions and related disciplines from both public and private sectors all around the country including guests from the Asia-Pacific region. Subsequently, Ms. Angelina R. Bustos, President of PSND, Inc. introduced this joint convention’s keynote speaker, Secretary of Health and Chair of the National Nutrition Council Governing Board, Dr. Paulyn Jean B. Rosell-Ubial.

As the new Secretary of the Department of Health (DOH), Dr. Ubial talked about her commitment in promoting President Rodrigo Duterte’s health agenda “Lahat para sa kalusugan, tungo sa kalusugan para sa lahat” (“All for health towards health for all”). The said agenda aims to improve the health conditions of Filipinos by the end of 2022 through continued implementation of successful health programs and policies which were also started by the past health secretaries that aims to establish a solid foundation of healthcare in the country.

Dr. Ubial emphasized on the three-pronged strategy to optimize assets and reduce inequalities in health which then aims to achieve health goals including, (a) providing health services to the poorest population; (b) protecting Filipinos from the triple burden of illness; and (c) promoting world class Filipino health professionals.

Dr. Panlasigui, then introduced the joint convention’s guest of honor, Vice-President of the Philippines Maria Leonor G. Robredo. Vice President Robredo shared that malnutrition cannot be solved by feeding program alone. She described that the solution to malnutrition comes in four (4) interconnected parts which are (a) food security and support for agriculture, (b) national feeding program, (c) sustainable livelihood, and (d) innovation in the government food procurement process. She quoted, “The first freedom that has to be won is freedom from hunger because if you’re always concerned on where the next meal will come from, everything else becomes irrelevant”.

Vice-President Robredo stressed that the government should take the lead and create partnerships among private sectors in strengthening the Philippine agriculture through providing support services among the farmers and fisher folks especially the small-scale producers. Some of these support services to be provided by the Department of Agriculture (DA) and Department of Agrarian Reform (DAR) are training programs on production, harvesting, and government procurement process, subsidized farm equipment, facilities for storage and harvesting, capacity-building, assess to crop insurance and credit at low interest among others. This is because most of the small-scale food producers are among the poorest in the community who do not have their own land and lack access to credit due to absence of collateral.

She also shared that the national feeding program, would be facilitative if food items will come from small-scale food producers. She emphasized how having a national feeding program can not only address hunger and malnutrition in the Philippines but also support our local farmers at the same time. In her submitted National Food Security Bill, among its main objectives are to streamline the food procurement and distribution nationwide and promote universal feeding program for ages 1 to 13 years old. However, the downside of such feeding program is that most of the time, it is already too late for the child to catch up due to late administration of the intervention, whereas the critical period of life start at the conception until the second year of the child’s life. Given this, she proposed that the National Feeding Program should not only be limited to school children but should also include pregnant mothers and very young children who are still out of school.

The impact of the National Feeding Program will help Filipino farmers and fisher folks to have a sustainable livelihood due to a constant demand for their products. This will only happen if the government procure at least about 30% of their produce. With this, the small-scale food producers should be exempted from the traditional government procurement process for them to easily transact with the government. Furthermore, Vice-President Robredo stated the need for a National Food Security Council that will oversee the procurement, distribution, and targeting of the beneficiaries.

In conclusion, she encouraged the participants to be open-minded for innovations and solutions in addressing malnutrition in the country. She further reminded the participants that solving nutrition problem is not a one man’s job but a joint commitment of all its stakeholders, she quoted, “Collaboration is our most important resources, and when we work together, the impossible becomes possible”.

On the way to good nutrition for optimal growth and lifelong health

The plenary session revolved on the contribution of proper and good nutrition in achieving optimum health in the perspective of the first 1000 days.

Dr. Amado R. Parawan, Health and Nutrition Advisor of Save the Children International Philippines, talked about “The importance of maternal nutrition in birth outcomes and lifelong health”. He explained the importance of nutrition throughout the life cycle as part of achieving the Sustainable Development Goals (SDGs) related to nutrition and health. He expounded that there was no quick fix to solve the multifactorial nature of health and nutrition problems as it will require a multi-sectoral approach in order to achieve the SDGs. He further emphasized on the role of good maternal nutrition before, during, and after pregnancy in promoting health throughout the later life of the infant.

Mr. Martin Bettelley, Deputy Country Director of the United Nations-World Food PRogramme (UN-WFP) shared about, “World Food Programme (WFP) programs addressing stunting”. His presentation tackled the alarming problem of stunting in the Philippines with data reporting that the Philippines is currently ranked 9th in the world with the leading number of stunted children under five years old. He discussed that with stunting, national economic development is also impaired in addition to the biologic and cognitive development of individuals. With this concern, he presented the WFP Stunting Prevention Program which includes livelihood, school feeding and stunting prevention. This program aims to address stunting using a holistic approach. At the end of his presentation, he stressed the importance of good nutrition in securing a better life for children in the future.

Dr. Willibald Zeck, Chief of Health and Nutrition United Nations Children’s Fund (UNICEF) Philippines, asserted the big role of sanitation and hygiene practices in the process of nourishment in his presentation on “Integrating Water, Sanitation, and Hygiene (WASH) in the first 1000 days”. According to Dr. Zeck, more than just having healthy and balanced meals, there is also a need to ensure the safety of food and water to be consumed hand-in-hand with good personal hygiene and sanitary practices.

Dr. Zeck pointed out the need to integrate WASH practices and nutrition in the first 1000 days. Backed with different scientific literatures and published researches, he discussed how environmental enteropathy diseases (EED) adversely affects nutrient utilization thus, having an impact to the overall nutritional status of an individual and how practicing WASH can alleviate and prevent risk of EED. He also showed the significance of WASH practices in maximizing the impact of nutrition interventions during the first 1000 days of life.

Mr. Roberto D. Gajo, Provincial Nutrition Action Officer (PNAO) of Quezon Province, concluded the plenary session with his presentation on “Optimizing community nutrition interventions for the first 1000 days”. Mr. Gajo proudly presented the nutrition program which Quezon Province is currently implementing called “Quezon First 1000 Days of Life” or Q1K. This program follows an input-process-output mechanism whereas the community is highly involved in its implementation, spearheaded by the governor of Quezon. Furthermore, Mr. Gajo shared that Quezon Province is the first in the country to fully implement the concept of first 1000 days as part of its provincial nutrition policies and programs.

A luncheon symposium sponsored by Energen with Dr. Gemiliano D. Aligui, Clinical Epidemiologist of Institute of Personalized Molecular Medicine of The Medical City, presented the topic on “How proper nutrition can improve the nutrition of the country’s youth”. Dr. Aligue used the data and information gathered from the result of the Feeding Program of Energen in his presentation. He explained the

relationship of good nutrition in early childhood with productivity during the later life and preventing infant and child mortality and its implication on formulating appropriate interventions. He likewise pointed out the importance of providing appropriate interventions from conception and before the age of four to help children achieve better health towards their later life.

Another symposium sponsored by DSM Nutritional Products followed with the topic “Role of micronutrients in the first 1000 days of life” presented by Dr. Regina Moench-Pfanner, Founder and CEO of Ibn360. In her presentation, Dr. Moench-Pfanner reiterated the vital role of adequate nutrition during the first 1000 days of life as a life requirement to help meet global nutrition target, including a diversified diet to provide the necessary micronutrients, consumption of nutrient-dense foods during early childhood, and the challenge in implementing dietary recommendations.

Should a child become a mother: Addressing issues on adolescent pregnancies

The next session dwelt on the issues of alarming incident adolescent pregnancies and relevant stakeholders’ contribution in solving the issue through policies and programs.

Dr. Vanessa-Maria F. Torres-Ticzon of the College of Medicine, University of the Philippines-Philippine General Hospital (UP-PGH), gave a presentation on the “Health and nutrition needs of adolescent when pregnant”. In her presentation, she expressed that adolescent pregnancy is a public health concern which requires an adolescent-friendly approach to better help and educate the vulnerable teenagers.

To further understand the burden that every pregnant teenage Filipino girl carries from the psychological point of view, Ms. Hannah Misha M. Morillo, a psychologist representative from MLAC Psychosocial Services for Well-Being tackled the topic “The Filipino adolescent under stress and the problem of adolescent pregnancy”. According to Ms. Morillo, the increased sexual activity of Filipino adolescents or their engagement in premarital sex is brought by the spontaneous physical, cognitive and socio-emotional changes during puberty amplified by the shifting views on marriage and the changing Filipino family structures and values. Given this scenario, she advocated that sex education and the Reproductive Health law as crucial interventions to help the struggling Filipino teenagers manage their sexual behavior. With the concept of teenage pregnancy still unacceptable in our society, teenage and young mothers find it hard to seek help due to fear of being judged and discriminated. Ms. Morillo encouraged the participants to give more focus on the health and well-being of the child and the adolescent rather on what they have done. As she quoted from Dr. Ticzon, “Let us not judge them, let us listen to them”.

Following the psychosocial point of view of teenage pregnancy, a topic on “Policies and programs on the prevention and care in adolescent pregnancies” was presented by Dr. Juan Antonio Perez III, Executive Director of the Commission on Population (PopCom). He tackled the different programs that PopCom is currently implementing to address the growing concern on adolescent pregnancies including early marriages, sexual transmitted infections (STI), and the negative effects of early pregnancy to the growth and development of young individuals. According to Dr. Perez, there is a need for programs and methods which are culture-sensitive, holistic, interdisciplinary, sustainable, and replicable. Among the different policies that are being implemented, focus should be on responsible parenthood and family planning, adolescent health, and population and development integration. In general, Dr. Perez recognized that empowering youth can help in the prevention of teenage pregnancy thus, most of

PopCom’s strategies revolved on providing information, education, communication, and services among the youth including their parents. Among the activities conducted are holding population quiz contest and film-making competition, creating and disseminating education materials, conducting discussion programs such as the “Youth for Youth” (U4U).

Representing Director Patricia B. Luna of the Council for the Welfare of Children (CWC), Ms. Grace Alejandrino, discussed the different government initiatives on adolescent pregnancies. She gave a run through of the different international and local policies which protects the right of every individual with emphasis on the welfare of women and children. Among these are the United Declarations of Human Rights, Solo Parent Act (RA 8972), and Magna Carta of Women (RA 9710). She furthered her discussion with the different actions and initiatives done by CWC and its key agencies such as the Department of Education (DepEd), Department of Social Work and Development (DSWD), and National Youth Commission (NYC) which target addressing concerns on children and adolescent health and sexuality. Despite the numerous initiatives of different government agencies, there are still gaps that hinder the complete provision of different services. Among these gaps and challenges are lack of funding, technical expertise, repository of data, and facilities.

Newborn care, exclusive breastfeeding and complementary feeding

This session tackled on the benefits as well as issues and concerns in implementing infant and young child feeding intervention as part of the First 1000 Days initiative.

Dr. Maria Asuncion A. Silvestre, Neonatologist and President of Kalusugan ng Mag-Ina, Inc., shared Early newborn care and strategies to ensure immediate, exclusive, and continued breastfeeding through the Unang Yakap, this is a set of nutrition specific interventions that aims to eliminate unnecessary breastfeeding practices. She emphasized the underlying principle that both mother and child should be treated as a dyad, they should not be separated. She added that there is need to encourage involvement of academe particularly the college or department of nutrition in advocating for the implementation of the Unang Yakap and to give correct messages. She urged the participants to take pride that Unang Yakap was initiated here in the Philippines and that through social marketing Unang Yakap becomes The First Embrace, which was adopted by the World Health Organization Western Pacific Region and the UNICEF Eastern Pacific Region, and now applied to various countries.

Dr. Marie Anne C. Corsino, Pediatric Consultant and Consultant Area Leader of Eastern Visayas EINC Scale-Up Implementation, started her presentation principles and policy of Unang Yakap with a video showing of the old practice of newborn care in contrast with the Essential Intrapartum and Newborn Care or the EINC. She also shared the four core steps in immediate newborn care and emphasized how it saves lives. She added that skin-to-skin contact is not purely for mother-baby bonding but it also increases the chance of successful breastfeeding. She also cited a study done by the late Dr. Natividad Relucio-Clavano in Baguio General Hospital in 1970s which demonstrated the damaging effect of non-rooming-in of babies with their mothers. She also presented regulation policies such as Milk Code that emphasizes the non-acceptance of gift from formula milk or their representatives.

Dr. Jossie M. Rogacion, Professor in Pediatrics of the College of Medicineof UP-PGH started her lecture on When baby asks “What’s in my milk?” with a cliche that breastmilk is best or breastmilk is the gold standard in infant feeding. She shared that breastmilk is difficult to copy since lactose content of other milk is low. She characterized the components of breastmilk into three: (a) nutritional components (macro- and micronutrients) which is almost 100% adequate including some specific micronutrients only found in the breastmilk; (b) the non-nutritional components such as bioactive factors which strengthens the babies’ immune system; and (c) harmful components such as pollutants, drugs, allergens, and viruses which are passed from the mother but could be avoided. She added that the nutrients in breastmilk is more bioavailable and its protein whey which is highly soluble, easily digested and it contains higher amounts of tryptophan and cysteine. While formula milks are also dominantly whey, human milk whey in its structure is still more digestible. Same goes with the human milk casein and cow’s milk casein. The latter forms harder curds which is indigestible. With regards to fat, the percentage composition from both human milk and cow’s milk and its formula is almost the same but the quality is different. Human milk has a lipid system which contains milk fat globules and with high concentrations of fatty acids palmitic, oleic, linoleic and linolenic acid. It also contains DHA and amino acids which are related to brain development and visual activity. These said nutrients are not found in cow’s milk. Another important factor about human milk with regards to fat is that it contains lipase, an enzyme for fat digestion. This is absent in cow’s milk and formula milk so again, it is harder to digest. Dr. Rogacion shared that in a study by Anderson et al., it was found that breastfed infants had higher IQ compared to formula-fed babies. She also reiterated that breastmilk is not just nutrition but also medicine. Up until today, a full list of components of breast milk is still not yet achieved and as time progresses more and more nutrients are found and discovered in breast milk that are needed by the body for various functions. Dr. Rogacion also reiterated that a feeding session must be complete, as well as the time of feeding must be proper for the components of breastmilk varies due to these factors. She ended her talk with a statement that nothing can compare breastmilk since compositional differences exist among human milk, cow’s milk and even infant formulas.

Dr. Juliet O. Sio-Aguilar, Professor and Chair Pediatrics of the College of Medicine of UP-PGH expounded and categorized the barriers to successful breastfeeding with her topic on Resolving the issues when breastfeeding becomes difficult. She cited underlying issues on why breastfeeding may be difficult such as personal and family hurdles especially the misconception that the mother is unable to produce milk. The solution for milk insufficiency is proper latching of the infant on the breast as well as initiation of milk expression within six hours of delivery especially within the first hour for very low birth weight infants. In addition, Dr. Aguilar added that babies do not need supplementary water since breastmilk is mainly water. The next issue that hinders breastfeeding is breast or nipple problems, resolved with breast or hand milk expression and cold compress. She stated that these issues can be resolved by how determined the mother is. Others issues are persistent nipple pain, which was cited to be temporary and where majority of mothers experience but would still be able to produce milk; child refusal which could be infant related wherein the baby might have complications such as URTI, GERD, nasal obstruction and could also be a sign of teething; maternal related child refusal can be brought by mastitis; and lastly,

milk insufficiency that leads to child refusal but Dr. Aguilar emphasized that it is a misconception. She added that for mother with tuberculosis, isolation is only necessary when the mother is still infectious or if the virus developed to be multi-drug resistant. She also tackled that issue of inverse relationship of stress and breastfeeding, where misconceptions add up to stress and hinder or affect the production of breastmilk. She also discussed the need to empower the spouses because it was found out by various studies that support from them improves breastfeeding rates significantly. Lastly, Dr. Aguilar pointed out the effect of healthcare professionals and facilities to breastfeeding where insufficiency of professionals with enough nutrition counseling experience has a negative impact to breastfeeding rates. She challenged the participants to do something about this in their own communities and hospitals. Not enough breastfeeding breaks, lack of breastfeeding and child care units and short maternity leave in the Philippines also hinder successful breastfeeding experience.

Ms. Mildred O. Guirindola, Senior Science Research Specialist of the FNRI-DOST presented the results of the FNRI-DOST survey between 2013 and 2015 on Infant and Young Child Feeding (IYCF): Status and constraints in the Philippines. Breastfeeding initiation within one hour after delivery declined and pre-lacteal feeding or giving of liquid in the first three days after delivery including breastmilk substitutes has increased. Further, results of the study also showed that among 0-5 months old infants, there was decline in the proportion of exclusive breastfeeding and there was a decline in the proportion of exclusive breastfeeding rate for 6 months duration. Among one year olds, proportion of continued breastfeeding increased, also among two years olds. There was a slight increase in the proportion of infants 6-11 months old and among 12-23 months old who continued breastfeeding with complementary feeding. It was found out that infants in urban areas, infants born in families belonging in the rich quantiles and infants born in private hospitals are more likely to receive pre-lacteal feeds. With regards to being exclusively breastfed, the proportion decreases with education and non-working mothers are more likely to exclusively breastfeed their babies. The major reasons cited by the mothers as to why they don’t breastfeed exclusively is their perception that they cannot produce enough milk and their work.

Research sharing session

Dr. Leila Africa shared her research on Knowledge, Attitude, and Skills on Infant and Young Child Feeding Counseling of Trained Barangay Nutrition Scholars in CaLaBaRZon’s Two Provinces. Results show that there are changes and improvements that need to be done. It was found out that the knowledge about IYCF, and their counseling skills were below the passing rate. In addition, the knowledge about complementary feeding also needs improvement as well as their knowledge about growth charts, identification and explaining low birth weight and food fortification. The barangay nutrition scholars were confident on counseling although their perception on the sole accountability of the mothers on IYCF as well as their perception that IYCF is tiring to do needs improvement. Lastly, eight out of ten students cannot asses the children accurately as well as three out of ten scholars failed on assessing

current breastfeeding practices based on indicators. Resources might also cause the abovementioned problems for 2nd and 3rd class municipalities had poorer scores for the knowledge, attitudes and practices on IYCF compared to 1st class ones. Dr. Africa also suggested that there should also be improvement with the passing of information from the national level down to the roots for it was found out that trainers who were taught by national trainers were more likely to have poorer KAS than those who were educated by local trainers. She left a message that if we rely heavily with the barangay nutrition scholars in the improvement of IYCF practices, then maybe something should be done to improve the way things are being taught to these nutrition workers.

Dr. Jovina Sandoval shared her topic on Pingang Pinoy for pregnant, lactating, women and children 3+ years. For better visualization, the food guide was translated to a food plate model, thus, the formulation of Pinggang Pinoy. Since different age groups have different energy and nutrient needs, a specific Pinggang Pinoy model for each age group was created. The guiding principles in the creation of each Pinggang Pinoyspecific for each age group is based on: promotion of good health, sound scientific basis, focus on total diet, usefulness, attainability, flexibility, practicality and adaptability. The computations food proportions for achieving a range of nutrients on each plate was based on the Philippine Dietary Reference Intakes (PDRI) values. In this plate, it was made sure that it is easily understood by everyone. The model makes it easier for people to know the recommended proportions for meat and alternatives, rice and alternatives, fruits, and vegetables. Rice and vegetables having the same proportion and almost occupying more than half of the plate emphasizes that it must be consumed in that proportion compared to the meat and fruits that both comprise one fourth of the plate.

Dr. Marie Te. Bugas also shared her research on The First 1,000 Days Window of Opportunity: Palawan Experience. According to the results of the research, the combined nutrition interventions of feeding children and pregnant mothers with nutrition education, food production and food technology transfer proved to be an effective strategy towards the goal of the Food and Nutrition Research Institutes of providing support through efforts towards improving maternal and child’s nutritional status. The implementation of nutrition interventions based on the first 1000 days found to be effective and the government of Palawan allocated funds for further implementation and expansion of the program.

Crafting an effective elevator pitch to promote, support, execute First 1000 Days initiatives

An activity on crafting an effective elevator pitch to promote the First 1000 Days initiatives was moderated by Ms. Rosana Padua-Macahor, Certified Breastfeeding Counselor and Administrator of Breastfeeding Pinays, Inc. and Ms. Jovita B. Raval, Chief of the Nutrition Information and Education Division of the DOH-National Nutrition Council. The activity highlighted the importance of communication ant its vital role in formulation and implementation of projects. Ms. Padua reiterated the importance of knowing the audience as for communication to be more effective. To quote, “The thing that convinces the person to want more to hear about your cause and get hooked in your project is for them to be able to convince themselves.”

Followed by Ms. Padua’s talk, Ms. Jovita B. Raval gave the mechanics and tips for crafting an elevator pitch and how to make sure it is effective. According to her, an elevator pitch should only last for 20-30 seconds. In addition, Ms. Padua noted that in crafting elevator pitches, one must know first the audience and the factors that contributes to their decision making; second, is the objective, action and the behavior; third is how to gather ideas and formulate a thesis. To be able to relay an elevator pitch, one must make it appealing by making the design or delivery attention catching by using rational, emotional and human interest. Lastly, one must have an evaluation to tell whether the pitch is successful or not. With these mechanics and tips, an exercise was executed. Participants were grouped into two and they were asked to craft an elevator pitch.

Dr. Luisito Lido, Head of the Nutrition Committee and Training Officer of the Clinical Nutrition Fellowship Program of St. Luke’s Medical Center discussed about the Evolution of diets, as part of the luncheon symposium sponsored by Monsanto. After which, he discussed about genetically modified foods and the science and safety behind these products.

Business meetings, fellowship, and awarding

Business meetings of the two organization were also conducted during the convention. The PSND Business Meeting was facilitated by its President, Ms. Angelina R. Bustos. Ms. Bustos led the participants to pledge their commitment as members of the PSND, Inc. She also presented the status of involvement of PSND in various activities and partnership with other stakeholders as well as the financial status of the organization. The PAN Business Meeting was also chaired by its President, Dr. Leonora Panlasigui.

In addition, a fellowship dinner where participants enjoyed each other’s company, getting to know each other, through a night of dancing and entertainment, with exciting prizes given away by raffle draw was also conducted.

Other activities conducted is the recognition of the winner for the PAN-PSND Video Making Contest, PAN Most Outstanding Student in Nutrition and Dietetics, PAN Most Outstanding Student Chapter, PAN Fellow Award, and PAN Award for Pabasa sa Nutrisyon.